Acidity, reflux (GERD) & IBS care in Guwahati

Acidity, gas, reflux, IBS — are they the same?

"Acidity" is what most people call any burning, bloating or discomfort in the upper tummy. Doctors separate it into a few different problems, because the tests and treatment are different. They often overlap in the same person.

These are called functional disorders: the gut is not damaged, but the symptoms are real. They are the commonest reason people see a gastroenterologist.

Northeast India has some of the highest rates of stomach and food-pipe cancer in the country, and tobacco, gutka and areca nut (supari) add to the risk. That is one reason warning signs here deserve a low threshold for endoscopy, rather than months of antacids.

GERD (acid reflux)

How it is diagnosed

If your symptoms are typical — heartburn and regurgitation — and you have none of the warning signs above, guidelines support starting treatment first, without an endoscopy. A gastroscopy is advised if there are warning signs, if symptoms do not settle with treatment, or if you have had reflux for many years with certain risk factors (see the table below). In some people the reflux is confirmed with a special test only if treatment fails and surgery or other procedures are being considered.

Many gastroscopies show a normal food pipe despite troublesome symptoms. This is common, and it does not mean that the symptoms are imaginary.

Treatment — what actually helps

• Lose weight if you are overweight. Even a few kilos reduces reflux. Belly fat pushes the stomach up.
• Finish dinner 2–3 hours before lying down. Late, heavy dinners are one of the commonest causes of night-time reflux.
• Raise the head end of the bed (about 15–20 cm, with blocks under the legs, not extra pillows) if symptoms are worse at night.
• Stop smoking. Avoid tobacco chewing, gutka and areca nut — apart from the cancer risk, they do not help the food pipe.
• Cut only what clearly triggers you. There is no single "acidity diet" that suits everyone. Common triggers are large oily meals, fried food, very spicy dishes, pickles, tea or coffee on an empty stomach, carbonated drinks and alcohol. A short symptom diary shows what is yours.

Acid-reducing medicines (PPIs)

Proton pump inhibitors (pantoprazole, rabeprazole, esomeprazole and others) are the most effective medicines for reflux. Used correctly they work well, but they are often taken wrongly or for too long.

• Timing matters: take it once a day on an empty stomach, 30–60 minutes before the first meal. Taken after food, it works much less well.
• A typical first course is 8 weeks. If you are well, the dose is then lowered or stopped, or taken only when symptoms return — not continued by default for years.
• Some people do need long-term treatment — for example, those with erosive oesophagitis or Barrett's oesophagus. For them, the lowest dose that keeps symptoms away is used.
• Stopping suddenly can cause a temporary rebound of acid symptoms. Stepping down gradually usually avoids this.
• Long-term PPI safety: several possible risks have been reported in observational studies, but a clear cause-and-effect has not been shown for most of them. Take it when you need it, for as long as you need it, and review it — neither fear it nor take it indefinitely without review.
• Combination tablets (acid reducer plus a "gas" or motility medicine such as domperidone or levosulpiride) are often continued for months without review. These extra medicines have their own cautions and are not needed for everyone.
• Antacids and alginate syrups relieve occasional symptoms quickly; a bedtime acid reducer (such as famotidine) is sometimes added for night-time symptoms.

If symptoms persist despite a proper trial of treatment, the diagnosis is reviewed — gastroscopy, a check for other causes (including H. pylori, food-pipe and stomach-emptying problems), and in selected cases further testing before anything like anti-reflux surgery is considered.

Dyspepsia, gastritis and H. pylori

If the main problem is upper-tummy pain, burning or early fullness rather than heartburn, this is dyspepsia. Helicobacter pylori is a stomach infection that is very common in India and can cause gastritis, ulcers and, over decades, raise the risk of stomach cancer. In people with dyspepsia and no warning signs, guidelines recommend testing for H. pylori and treating it if present, rather than giving acid reducers indefinitely.

• Testing: a stool antigen test or a urea breath test. Acid-reducing medicines (PPIs) should be stopped 2 weeks before, and antibiotics 4 weeks before — otherwise the test can wrongly come back negative. Please ask before stopping any medicine; do not stop on your own if you have a bleeding ulcer or other reason to take it.
• Treatment: a 14-day combination of medicines, usually with bismuth, chosen because antibiotic resistance is common in India. The exact combination is individualised.
• Confirm that it is gone: repeat the test at least 4 weeks after finishing treatment.
• If the infection is cleared and symptoms continue, this is functional dyspepsia: treatment is stepwise (acid reducer for a limited period, then a gut-motility medicine or a low-dose gut-nerve-calming medicine if needed) and symptoms can usually be controlled, though they may return.

Irritable bowel syndrome (IBS)

IBS is diagnosed by the pattern of symptoms (the Rome IV criteria), not by a test: tummy pain on at least one day a week for the last 3 months, linked to going to the toilet and accompanied by a change in how often you go or in what the stool looks like, with symptoms present for at least 6 months. Doctors group it by stool type: IBS-C (hard stools), IBS-D (loose stools), IBS-M (mixed) — the Bristol stool chart is used for this.

Which tests are needed

1. Blood tests: blood count, inflammation markers, thyroid and, particularly if you have loose stools, a coeliac antibody test (tTG-IgA).
2. Stool tests: faecal calprotectin to separate IBS from bowel inflammation, and stool examination for infections or parasites when relevant.
3. Colonoscopy only if there are warning signs, a high calprotectin, anaemia, persistent diarrhoea without a cause, a family history, or a first-time change in bowel habit after 45–50. It is not routine for typical IBS in younger people.

Treatment — step by step

• Understand it. Knowing that IBS is a real, common, harmless condition lowers symptoms by itself. Stress, poor sleep and anxiety make it worse; improving them helps the gut.
• Regular meals and sleep, not skipping meals, chewing slowly, and less tea, coffee, and carbonated drinks if they trigger you.
• Fibre — the right kind. For constipation or mixed IBS, soluble fibre such as ispaghula (isabgol) husk, started in a small amount and increased slowly, is helpful. Coarse bran often makes bloating worse.
• Low-FODMAP diet — a short, guided trial. FODMAPs are fermentable carbohydrates found in wheat, onion, garlic, some pulses and dals, milk, mango, apple and cauliflower. Cutting them for 2–6 weeks, then adding them back one group at a time, helps many people find their own triggers. It is meant to be temporary — a long strict list can harm gut health and nutrition, and works best with a dietitian.
• Medicines for the main symptom: antispasmodics (e.g. mebeverine, hyoscine) or peppermint oil for cramping; loperamide or rifaximin for diarrhoea; laxatives or prescription medicines for constipation. Low doses of certain medicines that calm gut nerve signals — far below the doses used for depression — help pain and loose stools when the above are not enough.
• Gut-directed therapies — CBT, gut-directed hypnotherapy, relaxation and regular exercise — have good evidence and are underused.

What has weak evidence: probiotics (if you try one, use a single product for about 4 weeks and stop it if there is no benefit), and a long-term gluten-free diet in people who do not have coeliac disease. Expensive "gut-health" supplements, and repeated tests when the first ones were normal, do not improve outcomes.

Do I need an endoscopy or colonoscopy?

Guidance is from international guidelines and is a guide only — the decision is made on your own history and reports. Most gastroscopies and colonoscopies here are done without sedation, with a throat-numbing spray for gastroscopy; sedation is available on request at Hayat Hospital. Read the preparation guide →

Common questions

Related